How much rates vary
Facilitymedian $15,849 · 10th to 90th $776 to $16,596Professionalmedian $3,236 · 10th to 90th $2,399 to $4,677
Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier None Typical Low $2,454.71 Median $2,951.21 Typical High $3,467.37 | Professional | None | $2,454.71 | $2,951.21 | $3,467.37 |
Anthem BCBS Setting Facility Modifier None Typical Low $12,589.25 Median $16,218.10 Typical High $16,982.44 | Facility | None | $12,589.25 | $16,218.10 | $16,982.44 |
Anthem BCBS Setting Professional Modifier None Typical Low $2,398.83 Median $3,311.31 Typical High $5,011.87 | Professional | None | $2,398.83 | $3,311.31 | $5,011.87 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,513.56 Median $1,949.84 Typical High $2,951.21 | Professional | 62 · Two surgeons | $1,513.56 | $1,949.84 | $2,951.21 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $380.19 Median $501.19 Typical High $758.58 | Professional | 80 · Assistant surgeon | $380.19 | $501.19 | $758.58 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $338.84 Median $436.52 Typical High $660.69 | Professional | AS · PA/NP assist | $338.84 | $436.52 | $660.69 |
Cigna Setting Facility Modifier None Typical Low $151.36 Median $707.95 Typical High $2,290.87 | Facility | None | $151.36 | $707.95 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $2,570.40 Median $3,548.13 Typical High $5,370.32 | Professional | None | $2,570.40 | $3,548.13 | $5,370.32 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $776.25 Median $812.83 Typical High $1,202.26 | Facility | None | $776.25 | $812.83 | $1,202.26 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $2,454.71 Median $3,235.94 Typical High $4,677.35 | Professional | None | $2,454.71 | $3,235.94 | $4,677.35 |
Martin's Point Setting Professional Modifier None Typical Low $2,511.89 Median $2,951.21 Typical High $3,715.35 | Professional | None | $2,511.89 | $2,951.21 | $3,715.35 |
United Setting Facility Modifier None Typical Low $776.25 Median $812.83 Typical High $1,202.26 | Facility | None | $776.25 | $812.83 | $1,202.26 |
United Setting Professional Modifier None Typical Low $2,398.83 Median $3,467.37 Typical High $4,786.30 | Professional | None | $2,398.83 | $3,467.37 | $4,786.30 |
12 more rates with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $1,230.27 Median $1,479.11 Typical High $1,479.11 | Professional | 52 · Reduced service | $1,230.27 | $1,479.11 | $1,479.11 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $489.78 Median $588.84 Typical High $588.84 | Professional | 53 · Discontinued | $489.78 | $588.84 | $588.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,862.09 Median $2,187.76 Typical High $2,187.76 | Professional | 54 · Surgery only | $1,862.09 | $2,187.76 | $2,187.76 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $371.54 Median $446.68 Typical High $446.68 | Professional | 55 · Aftercare only | $371.54 | $446.68 | $446.68 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $245.47 Median $295.12 Typical High $295.12 | Professional | 56 · Pre-op care only | $245.47 | $295.12 | $295.12 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,737.80 Median $2,041.74 Typical High $2,041.74 | Professional | 78 · Unplanned return to OR | $1,737.80 | $2,041.74 | $2,041.74 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,445.44 Median $1,479.11 Typical High $1,479.11 | Professional | 52 · Reduced service | $1,445.44 | $1,479.11 | $1,479.11 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $575.44 Median $588.84 Typical High $588.84 | Professional | 53 · Discontinued | $575.44 | $588.84 | $588.84 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $2,137.96 Median $2,187.76 Typical High $2,187.76 | Professional | 54 · Surgery only | $2,137.96 | $2,187.76 | $2,187.76 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $426.58 Median $446.68 Typical High $446.68 | Professional | 55 · Aftercare only | $426.58 | $446.68 | $446.68 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $288.40 Median $295.12 Typical High $295.12 | Professional | 56 · Pre-op care only | $288.40 | $295.12 | $295.12 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,995.26 Median $2,041.74 Typical High $2,041.74 | Professional | 78 · Unplanned return to OR | $1,995.26 | $2,041.74 | $2,041.74 |
Where Maine sits
The same service costs 21.4 times more in Alaska than in Texas. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.
Maine· 21st of 51
$3,311
AK $8,318TX $389
Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.